coronavirus – Page 2 – UAB Institute for Human Rights Blog

How Covid-19 Exposes the American Healthcare System

When I studied abroad in Spain, I had many discussions with my host family comparing the United States and Spain. These conversation topics ranged from politics, social expectations, and the weather. One topic that my host mother was especially interested in is the American health care system in comparison to the Spanish health care system. Spain has a universal health care system while still allowing private insurance whereas the United States has purely private insurance. Neither system is perfect. However, as the Covid-19 crisis continues to progress it is important to understand how the crisis brings to light the many issues with the American health care system.

A woman in a mask. — Woman in Mask. Source: Patrice CALATAYU. Creative Commons.

It is a well-accepted fact that the United States was significantly less prepared for the impact of Covid-19 than most other developed countries. By any metric of pandemic preparedness, America is significantly behind the rest of the developed world in regard to medical supplies. The country has a severe lack of health care infrastructure within the system; even before the international pandemic, the United States had fewer doctors and hospital beds than the majority of other developed countries. The United States lacks in the number of doctors per capita with 2.6 doctors per 1,000 people. The comparable country average is 3.5 per 1,000 people, which shows just how behind America is. The United States also has fewer hospital beds per capita than the majority of other developed countries. To make matters worse, America has some of the highest rates of unnecessary hospitalizations. These are hospitalizations of patients with chronic conditions that have preventable treatment, making it unnecessary for the patient to be hospitalized. With a pandemic such as Covid-19, these unnecessary hospitalizations are diminishing. However, in the beginning of the crisis within the United States, unnecessary hospitalization significantly slowed down the efficiency of the health care system in caring for Covid-19 patients.

An important trend in the preparedness of the United States for Covid-19 is that the United States, with a private health care system, was noticeably less prepared than countries with universal health care systems. It is true that universal health care is not the perfect response to pandemic emergencies like Covid-19. This is shown by Italy, a country who has a federalized national health insurance program. Italy still needed to lock down and for a while had the highest case and death rate than any other country. However, countries like Italy with universal health care were able to begin recovery and slow the spread of the virus much quicker than those without.

a hospital — Hospital Beds. Source: Presidencia de la Republica Mexicana. Creative Commons.

As health providers have been working tirelessly to make the necessary changes to care for Covid-19 patients, private health insurance companies have been making very few changes to their processes. One system health care providers have been implementing is telemedicine, a program that allows patients to securely consult with their health care providers virtually therefore easing the burden on the infrastructure of the hospitals. Despite President Trump expanding provisions on telemedicine, private health companies are not required to pay health systems for telemedicine. At the same time, while some insurance companies have waived some Covid-19 related costs, out-of-pocket expenses are not waived resulting in patients needing to pay thousands of dollars. To put these costs in perspective, in 2018 the average amount for a patient covered by private insurance admitted to the hospital for a respiratory condition similar to coronavirus was $20,000. Additionally, as hospitals across the country prepared for an influx of Covid-19 patients, stable patients without the virus were forced to stay in the hospital beds. These patients, who should have been moved to a rehab facility or released, were taking up unnecessary space due to private insurance companies taking multiple days to authorize the next steps for each patient. This has been a known delay in hospitals before the pandemic but now it is a delay that has dire consequences.

Quite possibly the biggest problem in the American health care system is cost. This problem is unique to the United States. Citizens are required to pay higher out-of-pocket costs than those in most other countries, leading Americans to forgo their health care in order to save money. Reports have shown that 33 percent of Americans reported a cost-related barrier to receiving care. This is in comparison to the 7 percent who reported the same in Germany. In 2019, a study showed that 33 percent of Americans also reported postponing medical care due to the cost of that care. It is only in the United States that citizens are risking thousands of dollars in order to seek help in a medical crisis like the one posed by Covid-19. A major concern across the world is that Americans will not seek care for corona symptoms due to the high costs of healthcare in the United States and the high amount of people without insurance in the country. This will spread the disease significantly faster than officials within the country would like to believe.

man with supplies — Medical Supplies. Source: Navy Medicine. Creative Commons.

As the Covid-19 cases rise in number across the country, an unusually high number of African Americans in the United States have been infected with Covid-19. This news, while terrible, is unfortunately not shocking and highlights the many racial inequalities in the health care systems. Coronavirus does not have a racial factor but the structural racism within the American health care system is evident. African Americans are over-represented in many essential workplaces making the population more at-risk than other populations. At the same time, African American populations are less likely to have health insurance coverage leading to a disproportionate number to not receive the necessary help from the health care system. There also exists a racial empathy gap that disproportionately affects African Americans and Hispanics within the United States. A racial empathy gap is when medical professionals show less empathy and sympathy to African American patients who are experiencing pain. Human rights workers have been working on mandatory reviews to ensure that health workers are providing an equitable form of treatment for minority patients. However, due to a bias developed and enforced by societal constructs of different races, there exists a higher risk for minority populations within the American health care system.

A few examples of problems within the American health care system that have been exacerbated by Covid-19 are highlighted above. While officials within this system and within the government must work to make necessary changes, it is also important to recognize the lifesaving and tireless health care workers who work within the imperfect system. Covid-19 has shown the country how necessary health care workers are. Nurses, doctors, surgeons, and so many other health care providers have dedicated an immense number of hours to fighting Covid-19. These individuals who are working to save lives within the corrupt health care system are extremely important and we must recognize their hard work while we work to make the system fairer and more equitable.

Where Social Distancing is Impossible

As the COVID-19 outbreak crosses borders throughout the United States, the Center for Disease Control has released recommendations for maintaining public health, which includes working from home, hand washing, and staying six feet away from any person, if possible. For the past few weeks, I have noticed people in my own community adapt to this new way of life. Kroger and Home Depot put masking tape six feet apart in the checkout lines, and every company I’ve ever heard of has sent me a helpful email explaining their own “pandemic plan.” Amidst the anxieties associated with this global pandemic, focus understandably turns to our immediate family and community. I may get frustrated about the lack of toilet paper in my local grocery store, but millions are incapable of following any of the CDC’s guidelines. Areas with a lack of hand-washing stations, affordable healthcare, clean water, internet, housing, and infrastructure do not allow for proper social distancing. Even at the United States’s southern border, relief agencies are struggling to address the growing pandemic.

Thousands of migrants along the United States-Mexico border are stuck in limbo. Many have fled from Central America, fleeing domestic violence, gangs, and death threats, to seek shelter in the United States. However, due to the threat of COVID-19, “The U.S. closed its border to asylum-seekers, Mexico suspended refugee processing, and many migrants are afraid to go home to their native countries, even if it were safe to travel.” Therefore, people seeking asylum are left on their own to find shelter, food, water, and medical care in a place that lacks these things when there is not a global pandemic occurring. Volunteers that would usually come to help have been quarantined, basic supplies have become hard to find due to panic buying, and any assistance from medical staff has been stretched thin as case numbers continue to rise in both Mexico and the United States. Additionally, asylum-seekers have to be concerned for their own safety even after they have made it to the border and received a court date for immigration hearings. Human trafficking, sexual assault, and gang violence are all risks in the camps, and since immigration hearings have been put on hold indefinitely, asylum-seekers have to wait even longer in these dangerous areas. Aid efforts become increasingly complex with more restrictions put in place by Mexican and United States governments each day.

Pew Research Center Graph showing countries that have closed their borders due to coronavirus — Source: Pew Research Center

As economies are negatively impacted by the virus, countries are becoming increasingly isolationist. 90% of the world’s population currently live in countries with restricted travel, while almost 40% live in countries with closed borders. These countries include Canada, China, Japan, and Ecuador, with Greece suspending asylum claims at its border with Turkey, much like the United States’s current policy with asylum-seekers at its southern border. Millions of United States citizens have filed for unemployment, and businesses and individuals are struggling to stay financially afloat and pay rent. It makes sense that countries like the United States are turning their attention to the plight of their own citizens, but according to the United Nations (UN) Secretary-General Antonio Guterres, “If we let the virus spread like wildfires, especially in the most vulnerable regions of the world, it would kill millions.” For many relief agencies and nonprofits, grants and funding for the year have already been distributed. However, the funds are typically earmarked for certain programs. Unfortunately, many of these programs, like funding for computer education, community engagement, and language classes, cease to exist in a world with COVID-19. Now, funding is needed to help displaced persons combat the threat of COVID-19, but it would require authorization to transfer funds from one program to another. Jan Egeland, Secretary-General of the Norwegian Refugee Council, has said that banks have not financially supported relief agencies who would help UN sanctioned countries like Iran and North Korea because they fear being sued by the US government. Bureaucratic lag in providing humanitarian resources will likely mean death for thousands, particularly those with limited resources. With donor countries being overwhelmed with their own coronavirus crises, where would the funding come from?

War-torn countries and refugee camps in countries like Syria and Sudan receive assistance from the UN in the form of educational, medical, and financial resources. When we see pictures of a child fleeing violence and war in Syria, it is understandable why the UN would come in to help. However, rhetoric around the US-Mexico border paints a different picture. Often, this population is thought of as simply a group of people seeking the “American dream”. In truth, these asylum-seekers and refugees are fleeing for their lives, just like refugees on other continents. Regardless of opinions surrounding citizenship and legal status, the reality is that thousands of people have come to this region to escape deadly violence. Executive Director of Global Response Management (GRM), an organization that provides medical care to vulnerable populations worldwide, Helen Perry explains the unique situation, “There’s not a lot of great oversight. Normally in a displacement situation, the UN would come in at either the request of the country they’re fleeing from or the country that’s receiving them…but unfortunately at the border that’s not happening because both governments [Mexico and the US] are sort of unwilling to admit that there’s a problem.” As a former nurse in the US Army, Perry is especially adept at assessing the needs of struggling communities. When she came to the US-Mexico border for the first time in 2018, she was surprised to see people facing similar levels of violence to patients she had helped in Yemen who had fled the Civil War there. Fortunately, her organization continues to provide aid along the border, but COVID-19 adds an additional layer of complications. The dire situation described above was her take last year, and her organization has had to make adjustments due to the pandemic, including creating a makeshift hospital. They’re not the only organization building makeshift shelters. A government agency tasked with building the US-Mexico border wall is currently creating semi-permanent lodging for its construction workers so they can continue building, despite concerns at COVID-19. These workers, like asylum-seekers on the other side of the wall, are worried about their health and how a lack of resources could impact them and their families.

Asylum-seekers and refugees have limited access to news updates, so there is a lack of knowledge in the camps about COVID-19 and its impact. Border towns like Tijuana are already overwhelmed with patients who are US citizens, so it would be virtually impossible for a non-citizen to get accepted should the need arise. They have been instructed by relief agencies to attempt to follow the previously mentioned CDC guidelines about social distancing and handwashing, but this is incredibly difficult in the camps. Tents are small, and many people have to sleep next to each other. Water stations and bathrooms are few and far between. As coronavirus tests are barely accessible to US citizens, finding one would be challenging for someone in the camps.

Discussions of this contagious virus have created anxiety for any empathetic person. Despite the grim reality, there are some positive efforts taking place. GRM is currently working on a twenty-bed field hospital near the Matamoros camps, although they may face more challenges as United States volunteers may not be allowed to travel there. Al Otro Lado, a legal services organization, and the Refugee Health Alliance have distributed medication and additional hand washing stations to many asylum-seekers. While there are few suspected cases of COVID-19 at the camps as of yet, these actions could be crucial in containing the virus should an outbreak occur. It’s important to remember wise words by Richard Blewitt, UN representative for the International Federation of Red Cross and Red Crescent Societies, “At this time we need global and local solidarity and compassion with all those affected by COVID-19, wherever they live.”

The Coronavirus in the Middle East: Its Impact on Sectarianism and Refugees

The coronavirus has spread to virtually every country of the world, but due to differences in privilege and access to resources, many countries are unable to adequately address this pandemic as well as other countries are. However, for countries in the Middle East, in addition to these differentials, the pandemic has also further exacerbated many preexisting problems that the region faces, namely political, economic, and social unrest. While this outbreak has had ramifications on several facets of life in the Middle East, this blog post will be focusing on the outbreak’s impact on sectarianism and the refugee crisis.

An image showing Shia Muslims visiting a shrine. — Shrine visitation. Source: Yahoo Images, Creative Commons.

Sectarian Conflict

The Middle East is marred by the Sunni-Shia conflict, and geopolitics are heavily influenced by this divide. Because of this, the divide is often invoked when something disastrous occurs in the region, with each side blaming the other, and the coronavirus outbreak has proven to be no exception. Although the coronavirus has spread to all Middle Eastern countries, Iran, a Shia-majority country, has been disproportionately impacted; as of March 31^st, Iran has had 44,605 coronavirus cases and 2,898 deaths, making it one of the countries with the most cases in the world. Further, Iran has now been identified as the source of spread to other Middle Eastern countries; some of the earliest identified cases in the Middle East were all of people who had recently traveled to Qom, one of the holiest cities in Iran. Despite the fact that people were aware of the outbreak in Iran, visitations to holy shrines in Iran were not discouraged, and people continued to travel to these holy sites. Any large gatherings during this time pose a risk, but shrine visitations are especially risky; many people engage in practices at shrines, such as kissing and touching the shrines, that lead to an increased likelihood of spreading. Since the outbreak is speculated to have spread from Qom, the city where one of the holiest shrines, the shrine of Sayyida Fatima al-Zahraa, is located, it is not unlikely that transmission did occur like this.

Because the spread has been identified as coming from Iran, many Sunni-majority countries in the Middle East have used this as an opportunity to justify further prejudice and discrimination against Shia Muslims. For example, Shia Muslims in Saudi Arabia who recently traveled to Iran for shrine visitations were labeled as traitors, leading some to call for their execution. In other countries, such as Lebanon, preexisting sectarian conflict has only gotten worse. It has been claimed that the first case in Lebanon came from Iran, leading many to blame the Shia Muslim population of Lebanon. Further, the Lebanese government continued to allow flights from Iran up until mid-March. Due to this, many have criticized Iran’s influence in Lebanon, specifically its influence on the government.

An image showing a Syrian refugee camp. — A Syrian refugee camp. Source: Yahoo Images, Creative Commons.

Refugees in the Middle East

There have been refugees in the Middle East for the past several decades, but the number of refugees significantly increased after the Arab Uprising in 2011. Because refugees often live in destitute conditions, the coronavirus outbreak would prove to be disastrous for them. Once a case of the coronavirus reaches a refugee camp, there will be little to nothing that can be done to stop its spread; large families live within the same tent, usually only five feet apart from other nearby tents. For this reason alone, social distancing is not an option for refugees living in camps, highlighting the intrinsic privilege of others’ ability to practice and call for social distancing. In addition to this problem, refugees also do not have access to the resources necessary for sanitization, namely due to lack of access to clean water. Further, there are often no established healthcare systems within refugee camps, making it difficult for them to access resources that would be needed to aid infected individuals. Even if refugees were to seek health care outside of the camps, it is not guaranteed that they would have access to this care. For example, many refugees are internally displaced in war-torn countries where hospitals have been demolished and those that are still standing are severely lacking in resources. Further, even when refugees resettle in other countries with established health care systems, it is not incorrect to assume that nationals of that country will be given preference over refugees for treatment and access to resources.

Despite the scarcity of resources and bleak outlook for refugee camps, measures have been taken to ensure that refugees are protected as best as they can be from the coronavirus. For example, many refugee camps have been sanitized with anti-bacterial spray. Certain organizations, such as Islamic Relief, have donated supplies, including rubbing alcohol and medicine that treats certain symptoms of the coronavirus, to ensure that if an outbreak does occur within a camp, there are some necessary resources available. Finally, the UNHCR has appealed governments for $33 million in funds to provide refugees access to hygiene kits, protective gear, and sanitary water, among other things, that could help deter the spread of the coronavirus.

Recently, an IHR Intern wrote a blog about racism and discrimination that arises during outbreaks such as this one. While Asians have largely been victims to racism during this period, in the Middle East, Iran and Shia Muslims have been targeted, highlighting that people do indeed try to blame such events on others when, in reality, there is no one that should be blamed. Further, times like this also highlight the level of privilege many of us live in; while we have the privilege to access resources and to distance ourselves from one another, other groups who lack such privileges, namely refugees, cannot practice any of these things. Thus, while we are all impacted by this outbreak, it is important to recognize that many people, in addition to worrying about the coronavirus, face other obstacles during this time as well, and these groups should be kept in mind.

Responding to COVID-19 in Developing Countries: An Appeal from Our Friends at Nashulai Maasai Conservancy in Kenya

Just a few short months ago, the IHR hosted Nelson and Maggie Reiyia from Kenya who spoke to us about Nashulai Maasai Conservancy, wildlife conservation, preservation of culture, and how to empower whole communities from the inside out, especially girls and women.

How long ago this seems now, in the midst of the COVID-19 crisis. The impetus of this blog post is Nelson and Maggie’s desperate appeal to help support their people who have been hit extremely hard by this crisis, and to show how COVID-19 affects people in the developing world.

COVID-19 in developing countries

While we have raised awareness of what this crisis means for some of the most vulnerable and marginalized in our own society, having to deal with a pandemic in developing countries is a whole different endeavor. The virus itself and the sickness it causes are only half of the danger. Major societal issues such as widespread poverty, economic deprivation, and lack of access to water, food, sanitation, and healthcare present huge challenges for people in the Global South. The COVID-19 crisis threatens already fragile economies and has the potential to negatively impact human rights, education, basic resource allocation, and food security. Under-resourced healthcare systems and hospitals are likely to be overwhelmed, creating a probability for higher death rates. A majority of people in developing countries also lack access to water and soap, increasing the likelihood of infections and facilitating the spread of the disease. In addition, there are no social safety nets or government bailouts for workers and businesses, exacerbating scarcity, political struggles, violence, and poverty.

Women and children talking in Maasai house. — Women and children in a Maasai house at Nashulai Conservancy. Source: Nora Nord, nashulai.com

In other words, it is not just the virus that threatens people’s lives in developing countries, but the whole context – poverty, underdevelopment, structural violence, lack of government resources to respond to the pandemic – that puts lives in peril and threatens the existence and survival of whole communities. People in developing countries are doubly at risk. This crisis will leave deep scars, not only with regards to lives lost, but also with regards to international development gains made in the last decades in development, human rights, and human dignity. These are the issues Nelson and Maggie are afraid of. They are not only worried about the immediate impact of this crisis on their people, but also about the setback this crisis will cause to the wildlife, economic, and cultural advances that have sustained and elevated their community for the last years and made Nashulai indispensable for their society. Their people, their project, and their way of life are in peril of survival.

What COVID-19 means for Nashulai Conservancy

Nashulai is a community-led conservancy in the Maasai Mara in the southwestern part of Kenya, close to the border to Tanzania. The Maasai are an indigenous community of strong and brave warriors, but poverty and lack of development have negatively affected their quality of life. Most Maasai exist on less than $1 a day, depending mostly on their livestock for food and income. More recently, due to Nashulai’s efforts, the community has been able to garner revenue through tourism by offering safaris and running guest houses and camps. About 2,000 people live on Nashulai’s 6,000 acre conservancy, and an additional 3,000 people live in the surrounding communities. Most of them reside in traditional Maasai villages, in which small dwellings arranged in a large circle for community living. Women, men, and children live together in small spaces and share food, resources, and chores with one another. Men mostly look after cows, sheep, and goats or work in local tourist camps and lodges, while women prepare food, raise children, and make jewelry and art work to sell to tourists. Livestock is sold on twice-weekly open markets in exchange for grains, oil, salt, and other basic necessities.

Picture showing a Maasai man with his cattle in a Maasai village. — The Maasai live in close-knit communities where women, men, and children of different families share all aspects of everyday life. Source: Marianne Nord, nashulai.com

COVID-19 has put all of this in danger. The markets are closed due to government safety measures, leaving people without food and without income. Tourist streams have run dry, which means no money and no jobs (90% of employed Maasai rely on the tourist industry). The communal way of Maasai life is in direct opposition to the guidelines of social distancing and self-isolation. There is no running water in Maasai homes, making constant handwashing not an option. Healthcare in the rural areas of Kenya is difficult access in the best case, and Sekenani health clinic in the conservancy is not equipped to deal with COVID-19 cases. It is unclear what should happen to people who become infected. There is a lack of information and education about the crisis, and an absence of guidance of what the WHO guidelines of handwashing, social distancing, and self-isolation and quarantine mean for people in places like Nashulai. There is no electricity beyond solar power, and while some people have phones or radios, spreading news and information is extremely difficult.

The situation is dire. People are starving.

Nelson and Maggie have developed an emergency plan to provide each household with basic food items, to repurpose part of Nashulai’s tourist camp to isolate sick people, and find ways to educate the community about safety measures and health. They have established a strategy on how they can become self-sustaining in terms of food production and continue their important conservancy work over the next months. However, because their stream of revenue has been cut, they rely on us, their friends, to support them, the Maasai people in their community, and the long-term survival of their project.

Please visit Nashulai Maasai Conservancy’s website if you would like to learn more and/or if you would like to donate to Nashulai Maasai Conservancy’s COVID-19 Emergency Fund.

Impact of Covid-19 in Conflict Zones

“Wash your hands.” “Avoid close contact with others.” “Stay home.” These are the CDC’s recommendations for protecting yourself against the coronavirus and the disease that it causes, COVID-19. For those of us fortunate enough to have clean water and soap and space and a home, that is helpful advice and easy enough to follow, even if it is somewhat of a disruption to our normal lives. Unfortunately, these recommendations are completely irrelevant to the millions of people across the globe who live in conflict zones and refugee camps where fresh water is scarce, sanitary facilities are lacking, and the healthcare infrastructure has been decimated by war and continuous violence. In places where day to day survival is already a key concern, the novel coronavirus poses a new kind of threat, one that the struggling healthcare systems in these countries is not prepared to take on.

While the U.S. government and media have focused on individual vulnerabilities, such as age and underlying respiratory conditions, very little has been done to address social and structural vulnerabilities, including limited access to basic services, health care, safe water, sanitation, and hygiene, in some of the most dangerous places in the world. Overcrowded refugee camps are a virus’ dream – they provide conditions in which the virus can spread rapidly and easily. Individuals living in these places are already prone to respiratory problems due to air pollution and living in close quarters. Unsanitary conditions and lack of housing, food, and clean water exacerbate the risk of contracting an infectious disease, and the lack of access to basic health care makes fighting any kind of infection difficult. The coronavirus is highly contagious and has a very high global mortality rate, even in places where social distancing and healthcare are accessible, and this rate will likely be significantly higher in conflict zones where large numbers of displaced people live. Preventing the virus from entering these spaces is the only hope, but as Dr. Esperanza Martinez, head of health for the International Committee of the Red Cross, has said, “this is uncharted territory,” and it is unclear how effective containment strategies will be in reality (or if they are even possible in certain places).

According to the Center for Strategic and International Studies, 126 million people around the world are in need of humanitarian assistance, including 70 million who have been forcibly displaced from their homes, mostly due to violence. COVID-19 is adding a new layer of uncertainty and fear to the already precarious and vulnerable status of these individuals and families. The UN High Commissioner for Refugees (UNHCR) and the International Organization for Migration have suspended refugee resettlement programs, and many governments worldwide have stopped the intake of refugees who are fleeing violence and food insecurity. Cases of COVID-19 have been confirmed in war-torn areas in the Middle East, including Afghanistan, the Gaza Strip, and Ninevah, a displaced persons camp in Iraq, as well as in several African countries, including war-torn Libya, Cameroon, and the Congo. This post considers how this global pandemic will likely impact people living in three particularly dangerous and vulnerable countries in the Middle East and West Africa: Syria, Yemen, and Burkina Faso.

Syria

Nine years into the seemingly endless civil war in Syria, more than 380,000 people have died, dozens of towns and cities razed to the ground and half of the country’s entire population displaced. Targeted attacks have left Syria’s once thriving public health care system in shambles. Hospitals and clinics have been destroyed or damaged to the point of not functioning. Medicine and medical supplies are limited, healthcare workers are few, and travel to the still-operational clinics and hospitals is out of the question for many of the sick and suffering. Of particular concern is the refugee camp in Idlib, a town in the northwestern province near Turkey, where many displaced individuals now live. The conditions of the camp are dire – there is limited access to soap and water and overcrowding makes social distancing impossible – so self-protecting is a major challenge.

Syria reported its first case of coronavirus a few days ago, from a woman who had recently traveled to Iran, a country that is backing the Syrian government in the civil war and where Shia pilgrims frequently travel. There are now five confirmed cases (the actual number is suspected to be much higher), and there is growing fear that the virus is spreading unimpeded throughout the northwest, where there is limited capacity to test and monitor the situation, but experts have warned that “if the disease starts, it will spread massively.” Jan Egeland, director general of the Norwegian Refugee Council, has warned that COVID-19 could “decimate refugee communities.” Containment is the only hope, but the shortage of supplies, including test kits, makes this unlikely.

Yemen

The United Nations has labeled the situation in Yemen the world’s worst humanitarian crisis. No cases of COVID-19 have been confirmed yet in Yemen, but the country is bracing for a devastating catastrophe if and when the virus arrives. Since the U.S.-backed war in Yemen began five years ago, Saudi and Emirati coalitions have leveled 120 attacks on medical facilities throughout the country. These attacks, including airstrikes, ground-launched mortar and rockets, and attempts to occupy hospitals and clinics, have led to widespread disruptions in access and service to some of the world’s most vulnerable people, including displaced women, children, and persons with disability. With a mere 51% of the country’s health centers operational, there is a severe shortage of medicine and medical equipment. Even if people in this area can get to a hospital, many hospitals don’t have electricity, rendering a ventilator — a potentially life-saving device for people suffering the most severe symptoms of COVID-19 — out of the question. The decimated healthcare infrastructure is unable to control preventable disease (there was a cholera outbreak a few years ago) and is completely ill-equipped to handle a pandemic. Both the Houthi rebel group (aligned with Iran) and the government recognize the threat the virus poses and are implementing precautionary measures, such as closing schools and halting flights into the area. However, both sides are amping up their rhetoric and are posed to blame the other if and when cases of COVID-19 are confirmed. The United States, for its part, has cut off emergency aid to Yemen, citing the Houthi’s interference in the distribution of supplies and services to starving Yemenis (likely a Saudi-directed approach), but humanitarian officials have warned that this decision will create major funding gaps in efforts to provide hand soap and medicine to clinics and to staff health centers with trained healthcare workers. Yemen’s basic healthcare programs are heavily reliant on foreign aid – about 8 out of 10 Yeminis rely on some form of aid. Eliminating this source of funding could mean suffering and death for millions of displaced persons in Yemen.

Burkina Faso

On March 18, Burkina Faso, the impoverished West African country of 20 million people, registered its first confirmed case of COVID-19. A week and a half later, that number leapt to146 cases, with hundreds more suspected, making it the hardest hit West African country so far. This tiny, conflict-scarred country is no stranger to hardships, including poverty, drought, rampant hunger, and militia-led coups. In 2019, clashes between government forces and militia groups linked to ISIL and al-Qaeda led to more than 2,000 deaths in Burkina Faso and forced more than 700,000 people to flee their homes. This escalation of violence has led to the closure of 135 health centers in the country, and an additional 140 have reduced their services, leaving 1.5 million Burkinabe in dire need of humanitarian health assistance. With a healthcare system that has been ravaged by war, a mere three facilities in the country are able to carry out the tests, and only a few hundred test kits have been provided. As part of the government’s response, Malian refugees once displaced into Burkina Faso are being forced back into Mali, where ongoing violence inhibits humanitarian and medical access to affected populations. COVID-19 will exacerbate an already dire situation — it is feared that an outbreak would see fatality rates of ten times higher than the global average. “These populations are already very vulnerable to diseases that are otherwise easy to treat,” says Alexandra Lamarche, senior advocate for West and Central Africa at Refugees International, “but that’s not the case when they have no access to water or proper sanitation or health care.” She adds, “We could watch entire populations vanish.”

Bumper sticker that says "All people are created equal members of One Human Family" — Source: Yahoo Images

Against a common enemy?

Rarely does a disaster – natural or otherwise – affect the entire world. The coronavirus is a different story, unlike anything we have witnessed in the modern age. It is exposing the fragility of even the most advanced economic, technological, social and medical systems, and it poses a grave threat to humans the world over. The virus doesn’t discriminate on the basis of status or religion or skin color or any of the other things that divide us or give us cause to fight each other. It travels across borders and between enemies, and the more people it infects, the greater the risk for everyone. Just like the virus, the distribution of basic human rights must not be qualified on the basis of anything other than humanity. Turning a blind eye to the suffering and inadequate conditions of the world’s most vulnerable populations only facilitates the spread of the virus. In a practical sense, limiting the spread of the virus in refugee camps and conflict zones in Yemen and Syria and West Africa is just as important as it is in wealthy countries if the goal is to eliminate the virus and end this global pandemic. That requires distributing resources and investing in large-scale infrastructure improvements in places where people are not able to follow the protocols for containment under the current conditions. As we scramble to make enough surgical-grade masks for healthcare workers in the United States to wear, we need to be concerned with sending as many as possible to medical facilities in places around the world that are under-served and over-taxed, including displaced persons camps. We cannot hope to protect ourselves if we refuse to protect our fellow humans, no matter the distance or cultural difference between us. U.N. Secretary-General Antonio Guterres has called this “the true fight of our lives,” insisting that we put aside our differences, which now seem small and inconsequential, and turn our aggression toward a common enemy. “That is what our human family needs, now more than ever.”

Breathing Lessons: Disability Rights in the Wake of COVID-19

The novel coronavirus (COVID-19) has provoked an unprecedented reality for much of the global population by streamlining widespread bureaucratic frustration, health anxiety, and social distancing. Most people know that older adults and people with underlying health conditions are disproportionately affected by COVID-19, although many people fall under both these categories and identify with a disability. Also, due to the limited resources available to treat people with COVID-19, concerns have emerged about who receives what type of care. This would force health providers with the grim task of dictating whose lives are worth saving. This blog addresses concerns about rationing care amid the influx of COVID-19 patients and how this might affect the largest minority group in the United States (26%) and world (15%), people with disabilities.

Word Health Organization suggests COVID-19 is particularly threatening to people with disabilities for a list of reasons: (1) barriers to implementing proper hygienic measures, (2) difficulty in social distancing, (3) the need to touch things for physical support (e.g. assistance devices; railings), (4) barriers to accessing public health information, and (5) the potential exacerbation of existing health issues. These issues add insult to injury because, even without COVID-19, people with disabilities by-and-large receive inadequate access to health care services. This is largely due to the competitive nature of health systems which value profit maximization and, thus, disadvantage people with disabilities as consumers in the health care market.

Recently, select states and hospitals have issued guidelines for health providers that would potentially deny people with disabilities treatment for COVID-19. Two entities, Alabama Department of Public Health (ADPH) and Washington State Department of Public Health (WSDPH), have recently come under scrutiny because of their efforts to fulfill such guidelines.

ADPH’s Emergency Operations Plan suggests that ventilator support would be denied to patients with “severe of profound mental retardation”, “moderate to severe dementia”, and “severe traumatic brain injury”. This controversial protocol has recently grabbed the attention of Alabama Disability Advocacy Program and The Arc thus leading to a complaint with U.S. Department of Health and Human Services Office for Civil Rights (OCR) regarding discrimination toward people with intellectual and cognitive disabilities.

With Washington notoriously being one of the first COVID-19 hotspots, WSDPH and the University of Washington Medical Center have come under fire for their plans to develop a protocol that would allow health providers to access a patient’s age, health status, and chances of survival to determine treatment and comfort care. These efforts have been confronted by Disabilities Rights Washington with their own complaint to OCR that declares any medical plan that discriminates against people with disabilities effectively violates the their rights and is, therefore, unlawful.

OCR swiftly responded to these concerns, as well as those from Kansas and Tennessee, by stating that, even in the case of pandemics, hospitals and doctors cannot undermine the care of people with disabilities and older adults. OCR Director Roger Severino exclaimed, “We’re concerned that crisis standards of care may start relying on value judgments as to the relative worth of one human being versus another, based on the presence or absence of disability,” and “…that stereotypes about what life is like living with a disability can be improperly used to exclude people from needed care.”

Also, with New York currently having most of the U.S.’s confirmed COVID-19 cases, they may very well be the first state to face the imbalance of available ventilators and patient demand. Disability advocates have recently decried verbiage in New York’s Public Readiness and Emergency Preparedness (PREP) Act that could provide immunity from civil rights for some patients. Thus, U.S. state and federal powers are playing tug-of-war with the status of disability rights during the COVID-19 crisis.

Not Today #COVID19 Sign Resting on a Wooden Stool. — Not Today COVID-19 Sign on Wooden Stool. Source: Pexels, Creative Commons.

However, these concerns are not limited to the U.S. In the developing world, many people with disabilities are segregated from their communities in overcrowded facilities, while thousands of others are shackled and incarcerated. This weak enforcement of disability rights positions people with disabilities, in countries such as Brazil, Croatia, Ghana, India, Indonesia, and Russia, at-risk of further inhumane treatment by receiving limited or no appropriate care related to COVID-19. As a result, Human Rights Watch urges state and local authorities to return these populations to their families and demand they provide needed support and services within their communities.

Nearly every country in the world has ratified the United Nations’ Convention on Rights of Persons with Disabilities (CRPD) which aims to fulfill the human rights and fundamental freedoms of people with disabilities. More specifically, Article 25 of CRPD suggests people with disabilities have the right to non-discriminatory health care and population-based public health programs. Thus, nearly every person with a disability around the globe is associated with a governmental power that claims to be dedicated to fulfilling the promise of CRPD. However, in the wake of COVID-19, will these words be put into action?

These unprecedented events are a turning point for how we view our bodies, health, and communities. This is also an opportunity to view the world through the perspective of those in your community such as people with disabilities who represent an array of impairments, challenges, and experiences. Despite boredom and apathy being at the forefront of many people’s isolation, images of life versus death surround others, and for a good reason. In these decisive weeks, and likely months, there has never been a greater time for people in the U.S. and abroad to acknowledge that disability rights are human rights.

Coronavirus and Racism

At this point, I’m sure almost everyone knows about COVID-19. With schools shutting down, conferences being cancelled, and travel being restricted, even those in uninfected areas are affected. However, while some of us are most worried about washing our hands and not touching our faces, some people have to worry about discrimination. Those of East Asian descent are being discriminated against all over the world, whether they’re from China or not, whether they’ve been in infected areas or not, whether they’re sick or not. COVID-19 is bringing out racism that has laid dormant, and, unfortunately, this isn’t the first time it has happened.

Historically speaking—especially before the scientific knowledge we have now—large outbreaks were blamed on minority groups. In 14^th century Europe when the Black Death occurred, many looked for an answer, and when they couldn’t find an answer, they found a scapegoat: the Jews. They were seen as nonconformists by the Christian majority and were subsequently blamed for the outbreak that would be known as the Black Death. Many were tortured until they made false confessions and killed, and their persecution continued centuries later.

Since then, almost every major outbreak has illuminated underlying racism within the global community: when syphilis appeared in Renaissance Europe every country blamed another; Irish immigrants were blamed for the 1830 cholera outbreak; and Mexicans and others from Latin American countries were discriminated against during the Swine Flu epidemic in 2009.

Most recently, the Ebola outbreak of 2014 brought out racism towards those of African descent. College admission was denied to two Nigerian students to Navarro College, and a Guinean high school soccer player attending school in Nazareth, Pennsylvania was heckled by the opponent’s fans, who chanted “Ebola” at him. Americans hesitated to shake hands with people of African descent, whether they were American or not, and the US imposed a travel ban to and from West Africa.

What we are seeing now with COVID-19, is similar to what we saw during the 2003 SARS outbreak. While the Ebola outbreak illuminated prejudices towards African Americans, in 2003, those of East Asian descent, regardless of their nationality were discriminated against in certain areas. The three Chinatowns in Toronto, Canada were empty for weeks, East Asians were constantly asked if they were sick when no one else was, and they were avoided when they went out in public. In Canada, there is the stereotype of yellow peril that labels Asians as “unsanitary, lower-class, and alien.” This stereotype obviously found root in SARS and only exacerbated these prejudices.

picture of xenophobia in the dictionary — Spiritual Xenophobia. Source: George Ian Bowles, Creative Commons

Unfortunately, it seems like we haven’t learned from these numerous outbreaks, and the racism and xenophobia along with COVID-19 is way more widespread and way more violent. A man attacked an unidentified woman was attacked on the subway in New York, and reports say that the confrontation was a result of the Asian woman wearing a mask. Like in 2003, the discrimination is not restricted to people of Chinese descent: a man singled out a Thai American lady on a bus in LA. He gestured at her while saying that “every disease ever came from China.” Finally, in Indiana, two men of Asian descent were denied a room at a hotel and told that if they were Chinese, they’d be “picked up and quarantined for two weeks.” All of these attacks were before any deaths occurred in the US.

These incidents aren’t unique to the Untied States either. In London, a student from Singapore was attacked in a busy shopping area. While he was being attacked his assailants told him, “I don’t want your coronavirus in my country.” He was left with fractures on his face, and he might need reconstructive surgery.

The racism that is emerging is not new, it has just been hidden. The fear that everyone is feeling is being redirected towards previous biases. The student from Singapore reported that he had been experiencing racist comments for the entire two years he had been studying in London. Because COVID-19 originated in China, the racism already present towards those of Asian descent has been exposed, and thanks to misinformation, it continues to grow. Fear has been shown to bring out the racism that already exists within people, not cause it.

In times like these it’s important to know the facts because that’s how we fight this discriminatory fear culture: Asians are no more likely to have COVID-19 than the rest of us. No one is any more likely to get COVID-19 because of their race or ethnicity. Despite the virus originating in China, there is no evidence Chinese people or Asians are predisposed to infection. Secondly, just because someone of Asian descent is wearing a mask, it does not mean they’re sick. In many East Asian cultures, it is normal to wear a mask year-round, not just when you’re sick.

It’s important to spread the facts. One of the biggest factors in discrimination is ignorance, so education is the best way to fight it. People are scared, and that is bringing out the prejudices they’ve kept hidden and might not even know they had. Additionally, catch and correct yourself when you think or do something with prejudice. Start improving our global community by improving your own thoughts.

COVID-19 is a pandemic, and it’s a serious infection, especially for the elderly and those with preexisting health conditions. However, the racism and xenophobia are spreading just as fast. As a global community, we shouldn’t add to the burden of this disease by using it as an excuse to be discriminatory.

A Time to Recognize and Safeguard The Rights That Connect Us

by Peter Verbeek, Ph.D. (Associate Professor, Program Director MA Anthropology of Peace and Human Rights)

A picture of a girl with a surgical mask covering her mouth and nose — Source: Yahoo Images

On March 6, 2020, the UN High Commissioner for Human Rights, Michelle Bachelet, issued a statement calling for an holistic human rights based approach to combat COVID-19. She wrote, “As a medical doctor, I understand the need for a range of steps to combat COVID-19, and as a former head of government, I understand the often difficult balancing act when hard decisions need to be taken.” However our efforts to combat this virus won’t work unless we approach it holistically, which means taking great care to protect the most vulnerable and neglected people in society, both medically and economically.” She added, “COVID-19 is a test for our societies, and we are all learning and adapting as we respond to the virus. Human dignity and rights need to be front and centre in that effort, not an afterthought.”

To heed Dr. Bachelet’s call we must remind ourselves of the fact that human rights are universal and inalienable, indivisible, interdependent and interrelated. We also must recognize that the essence of human rights is human dignity. All human rights arise from it and all human beings are born with it and posses it throughout their life span. Human dignity is not measured on a sliding scale. To illustrate, there is no difference in human dignity between that of the office holder of the Presidency of the United States and the migrant at the US Southern border. The accused in the court proceeding has the same human dignity as the judge presiding over her case. The convict and the prison guard do not differ in their human dignity. The human dignity of the disabled veteran is the same as that of the person pushing her wheelchair. And the human dignity of the COVID-19 patient in the isolation ward is the same as that of the health-care worker taking care of him.

The recognition of our shared human dignity and the safeguarding of the rights that arise from it is a powerful unifier in troubled times. Now that we are faced with a near global outbreak of an until recently unidentified corona virus we can stand united in the recognition that every person on this Earth has an irrevocable right to health care and security in the case of illness (UDHR, Article 25). With rights come responsibilities, and the unifying power of universal human rights is the way that each of us in accordance with our specific context and abilities has a role to play in safeguarding access to appropriate preventive and interventional health care and personal security regarding COVID-19. Our individual roles are necessarily varied, from driving a neighbor without proper means of transportation to a health care facility, to following “doctor’s orders” concerning personal hygiene or social distancing. If infected or taken ill we have a right to receive the best available care and the responsibility to follow the guidelines in place so as to minimize the risk of infecting others. Each of us has a responsibility to listen to the relevant and evolving science as communicated by medical experts, and each of us has the responsibility to comply with the local and national guidelines that are based on this science.

Some of those taken ill with COVID-19 will die in spite of our best efforts to care for them and protect them. If the fight to save their life is at the cusp of being lost we have the responsibility to see to it that their death reflects the human dignity that they possess. Medical science does not yet have the answer to the question of how to protect oneself conclusively against viral infections such as the current corona virus. That realization, while sobering, should not keep us from doing all we can in terms of what we do know about prevention. There is much that we can do to limit the risk of infection, provided we follow the relevant science. The human rights motto is that any infection, or worse, any death, linked to insufficient preventive measures is one too many, and we all stand united in this through the human dignity that each of us possesses.